Constipation in Polio Survivors

Category: Medical Help

From my standpoint as a specialist in Physical Medicine and Rehabilitation, the connection between constipation and post-polio syndrome is academic. i.e., it is an interesting discussion and may be important, but I am not sure it changes treatment. William M. DeMayo, MD

Here are some practical thoughts.

I would address the issue the same as a partial neurogenic bowel, i.e., in a stepwise fashion. It's hard to give a cookbook one size fits all answer, but some points would include the following:

High fiber diet can be key.

Keep up fluid intake, because in the absence of water, fiber turns to “concrete.” Due to mobility and bathroom access issues, some people need to limit fluid intake. If so, then avoid fiber.

Keep stool soft. If it is hard despite fluids and fiber, then add Colace® 50 or 100 mg two or three times a day.

If there are still problems, add regular use of Senna® (2 tablets up to 4 tablets) about 6 hours prior to planned bowel movement (BM).

Set a regular schedule to be on the toilet every 24 or 48 hours, so the bowels can develop a rhythm. Social issues sometimes necessitate M, W, F, but I encourage avoiding this since it makes it hard to "train" the bowels when the rhythm gets interrupted. For some it is best, after a large meal and some hot fluid, and, for many, that means in the evening.

If at all possible, be up (out of bed) on a commode to take advantage of gravity.

Do not give up on a routine due to a bad day or a few bad days. Bowel response to changes in routine can take a couple of weeks. Patience is key prior to making thoughtful changes.

Avoid saying "this" or "that" doesn't work for me since a combination of approaches often works when each individual approach did not. As an example, fiber and Colace® may be needed to prevent a hard stool but Senna® maybe needed to initiate the bowel movement yet none of these worked alone).

Avoid letting the interval of BM's exceed 3 days. At this point feces get dry and hard and they have generated gas internally, leading to colon distention. A distended colon loses even more of its contractile ability.

Additionally, peristalsis occurs by sequential reduction in the cross sectional area of the bowel. The cross sectional area of the bowel varies exponentially with the radius (Pi x Radius squared), but the circumference varies directly (2 x Pi x Radius), so a 50% reduction in the cross-sectional area occurs much more easily at a small diameter than a large distended bowel. The major point is: DON'T let the bowels get distended.

Use a Dulcolax® suppository or even a Fleet® enema to be sure bowels move "on schedule.” Once routine is established then try to taper to a glycerine (glycerin) suppository then digital stimulation, then nothing. If constipation reoccurs, go back and restart the next level up the chain, and continue to try to wean over time.

Lastly, have a healthy approach to using ANY bowel medication. I suggest not being "afraid" to use medications when needed. The long-term negative effects are not as severe as the long term negative effects of chronic constipation/impactions. At the same time, always try to thoughtfully wean from bowel medications and take the minimum amount needed for a consistent regular bowel movement. Avoid sudden or quick changes in medications - again patience is key.